TAVR valve durability supported in large follow-up

The data reported by Dr. Douglas are very important and very reassuring. It isn’t easy to evaluate long-term results in patients who underwent TAVR in the early days because that population of patients was old and at very high risk. Even when patients had successful procedures their longevity wasn’t long. Only about 10% of the starting population of 2,482 patients in Dr. Douglas’ study actually had echocardiography done after 5 years. To assess durability you need longer-term echo follow-up, but it will be very challenging to have enough patients to have statistical power to do that.

I am not nervous about long-term durability of TAVR in octogenarian patients, the most typical age for TAVR patients today and since we began using it. Durability is more of an issue for patients who are 75 or younger, and we will need data from 7- to 10-year follow-up of younger patients to have a reasonable answer. Younger patients who undergo TAVR may face more of a threat from valve deterioration simply because of their longer life expectancy. In addition, with surgical valves we know that younger age is one of the strongest predictors of valve degeneration.

What’s also important when evaluating long-term transcatheter valve performance is our ability to treat a prosthetic aortic valve that has deteriorated. That is just as important as valve durability. It’s not just an issue of which valve can last 8, 10, 15, or 20 years. It’s also an issue of when the valve deteriorates how easily can it be repaired with a valve-in-valve procedure. We don’t just want a durable valve; we want a valve we can easily treat when it fails. Some surgically-placed prosthetic aortic valves are very small and aren’t well suited to valve-in-valve replacement.

Danny Dvir, MD , is an interventional cardiologist at the University of Washington in Seattle. He has been a consultant to and received research support from Edwards, Medtronic, and St. Jude. He made these comments in an interview.